Salt Intake In Hypertensive Patients Research Articles

Relationship between the behavior change model and salt intake in hypertensive patients: a single non-specialized hypertension clinic prospective observational study.

We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2 ± 23.3 mEq/L at baseline to 56.9 ± 25.5 mEq/L at 12 months; P = 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7 ± 2.9 g/day at baseline to 8.4 ± 2.8 g/day at 12 months; P = 0.045). In addition, they also had significantly lower changes in urine sodium concentration (-13.1 ± 46.1 vs. -6.6 ± 59.7 mEq/L; P = 0.048), significantly increased changes in urine potassium concentration (5.7 ± 20.1 vs. -4.8 ± 28.6 mEq/L; P = 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (-1.3 ± 2.6 vs. -0.1 ± 2.6 g/day; P = 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.

Relationship between salt reduction readiness and salt intake in hypertensive patients: a single nonspecialized hypertension clinic case study.

This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject's level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = -0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.

Knowledge of Salt intake and Blood Pressure Control among Hypertensive Patients in a Tertiary Hospital

As the prevalence of hypertension increases in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge. High salt intake is an important risk factor for hypertension and its high intake prevents adequate BP control. This study aims to explore the knowledge of salt intake and blood pressure control among hypertensive patients. Data were collected from a cross-sectional sample involving 564 adult hypertensive patients that were followed for at least 3 months prior to recruitment to this study. Data collection comprised interviewer-administered structured questionnaires about demographics, knowledge and practices related to salt, followed by measurement of blood pressure. A majority (92.9%) of the respondents knew that eating too much salt could affect health and less than one-half (40.1%) actually knew that not more than one teaspoon of salt should be consumed daily. Nearly all respondents (516) knew high BP to be a possible consequence of high salt intake. Among those that took a lot of salty food, 87.7% and 78.5% had high systolic BP and diastolic BP respectively. Although the majority of respondents were knowledgeable about the adverse effects of salt, few knew the daily intake recommended value. The higher the dietary salt intake, the higher the chances of having poor BP control. Increased knowledge about recommended salt intake and individual guidance could be important for reducing salt intake in hypertensive patients.

Effect of salt intake on blood pressure in patients receiving antihypertensive therapy: Shimane CoHRE Study

BackgroundSalt intake is recognized as an important risk factor for hypertension in the general population. On the other hand, the availability of various classes of antihypertensive drugs means that it is generally not considered crucial to control the salt intake of hypertensive patients. In this study, we evaluated whether blood pressure (BP) was correlated with 24-hour salt intake in patients receiving antihypertensive therapy. MethodsA total of 1496 consecutive participants undergoing health screening examinations were recruited. Subjects were divided into two groups according to their antihypertensive medications checked on prescriptions: 1005 subjects without antihypertensive therapy (untreated subjects) and 491 subjects with antihypertensive therapy (treated subjects). The 24-hour urinary sodium excretion (24h-uNa), a surrogate marker for daily salt intake, was estimated with the formula proposed by Tanaka et al. in 2002. ResultsUnivariate analysis indicated that 24h-uNa was positively correlated with the systolic BP of both untreated and treated subjects. This was confirmed by multiple linear regression analysis after adjustment for confounding factors (untreated subjects: partial regression coefficient β=1.45±0.26, p<0.001; treated subjects: β=0.75±0.27, p=0.01). Salt intake was also correlated with the pulse pressure in both treated subjects (β=0.55±0.24, p=0.02) and untreated subjects (β=0.93±0.19, p<0.001). ConclusionThese results suggest the importance of reducing salt intake in hypertensive patients on pharmacotherapy, as well as in the general population. Further studies of hypertensive patients employing 24-h urine collection are warranted to confirm the present findings.

Trends in the awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic: A one-year follow-up study

The aim of the present study was to investigate trends in the awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic following guidance regarding salt restriction. Subjects comprised 107 patients (mean age 71 ± 12 years) who were followed at a hypertension clinic and 164 patients (mean age 68 ± 11 years) who were followed at a general clinic. Estimated salt intake using spot urine samples and awareness of salt intake using a self-description questionnaire were assessed in 2013 and one year after guidance regarding salt restriction. No significant changes were observed in office blood pressure at the two clinics. Estimated salt intake in 2013 was slightly lower at the hypertension clinic than at the general clinic (8.9 ± 2.5 vs 9.3 ± 2.5 g/day). Estimated salt intake decreased and the awareness of salt intake improved significantly after one year at both clinics; however, the reduction in estimated salt intake was larger at the general clinic than that at the hypertension clinic (−1.6 ± 3.2 vs −0.6 ± 2.9 g/day, p < 0.01). Individual guidance including data on actual salt intake appeared to be effective and important for reducing salt intake in hypertensive patients.

Awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic

The purpose of the present study was to investigate awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic. Subjects included 330 patients, with a mean age of 69 ± 12 years, who were followed at a hypertension clinic and 200 patients, with a mean age of 67 ± 11 years, who were followed at a general clinic. We estimated 24-h salt excretion using spot urine samples and checked the awareness of salt intake using a self-description questionnaire. The number of antihypertensive drugs available at the hypertension clinic was significantly higher than that at the general clinic (2.2 ± 1.1 versus 1.6 ± 0.9, p < 0.01); however, no significant difference was observed in office systolic blood pressure between the two groups. Urinary salt excretion was significantly lower at the hypertension clinic than at the general clinic (8.7 ± 2.5 versus 9.3 ± 2.5 g/d, p < 0.01). The rate of achievement of salt intake <6 g/d was 15% at the hypertension clinic and 6% at the general clinic. In patients with excessive salt intake (≥10 g/d), 28% of patients at the hypertensive clinic and 23% at the general clinic thought that their salt intake was low. Urinary salt excretion in hypertensive patients was lower at a hypertensive clinic than at a general clinic. This may be due to the professional nutritional guidance at the hypertension clinic. However, most patients could not comply with the guidelines, and the awareness of salt restriction in patients with excessive salt intake was low.

Characteristics of the hypertensive patients with good and poor compliance to long-term salt restriction

Although salt restriction is very important for the management of blood pressure (BP), it is difficult to maintain low salt intake in hypertensive patients. The purpose of the present study is to investigate comparatively the characteristics of hypertensive patients with good or poor compliance to long-term salt restriction. Subjects included 248 hypertensive patients who underwent successful 24-h home urine collection for >5 times with the observation period of 9.4 years in average. When the subjects were categorized based on the mean 24-h urinary salt excretion during the observation period to the groups with good (<8 g/day) or poor (10 g/day or more) compliance to long-term salt restriction, subjects with poor compliance were more frequently to be male, younger and had higher BMI than those with good compliance. Although there were no significant differences in BP and the number of antihypertensive drugs between the subjects with good and poor compliance, the subjects with poor compliance were given more diuretics, more frequently complicated with diabetes mellitus and hyperuricemia and had higher urinary protein excretion than those with good compliance. Thus, strict nutritional intervention and the management of BP as well as the complicated cardiovascular risk are important for the patients with poor compliance to salt restriction.

Determinants of Blood Pressure Response to Low‐Salt Intake in a Healthy Adult Population

Although the beneficial effects of lowering salt intake in hypertensive patients are widely appreciated, the impact of promoting dietary salt restriction for blood pressure (BP) reduction at the population level remains controversial. The authors used 24-hour ambulatory BP monitoring to characterize the determinants of systolic BP (SBP) response to low-salt intake in a large, relatively healthy Amish population. Patients received a high- and low-sodium diet for 6 days each, separated by a 6- to 14-day washout period. Variance component analysis was used to assess the association of several variables with SBP response to low-salt diet. Mean SBP was 0.7 ± 5.8 mm Hg and 1.3 ± 6.1 mm Hg lower on the low-salt compared with the high-salt diet during daytime (P=.008) and nighttime (P<.0001), respectively. SBP response to a low-salt diet was significantly associated with increasing age and pre-intervention SBP, in both daytime and nighttime, while the association with female sex and SBP response to cold pressor test (CPT) was significant only during nighttime. Our results suggest that salt reduction may have greater BP-lowering effects on women, older individuals, individuals with higher SBP, and individuals with higher SBP response to CPT.

Benefit assessment of salt reduction in patients with hypertension: systematic overview

We assessed the benefits and harm of reduced salt intake in patients with essential hypertension focusing on patient-relevant outcomes and blood pressure. A systematic search of five electronic databases was performed to identify high-quality secondary literature based on randomized controlled trials (RCTs). An update primary literature search (RCTs) was performed for the time period up to 2010 that was not covered by secondary literature. Major outcomes were death, cardiovascular morbidity/mortality, hospital stays, terminal renal failure, quality of life, and adverse events. Change in blood pressure was defined as surrogate parameter. Four different systematic reviews and two RCTs met the inclusion criteria. Only one review reported limited data on patient-relevant outcomes. Over an intervention period of up to 12 months, mean SBP was reduced by 3.6-8.0 mmHg in all reviews. For the same intervention period, a statistically significant advantage with regard to mean DBP reduction ranging from 1.9 to 2.8 mmHg was found in three reviews. The fourth publication reported a nonsignificant reduction (DBP reduction of 4.7 mmHg). None of the RCTs identified in the primary literature search update reported data on patient-relevant outcomes. However, both RCTs found blood pressure improvements with salt reduction. A benefit from a salt-reduced diet in patients with high blood pressure is not proven with regard to patient-relevant outcomes based on systematic reviews and RCTs published up to 2010. The results indicate a blood pressure-lowering effect through reduced salt intake in hypertensive patients.

Effectiveness of a Spot Urine Method in Evaluating Daily Salt Intake in Hypertensive Patients Taking Oral Antihypertensive Drugs

Kawasaki et al. developed a spot urine method (SUM) for evaluating daily salt intake using one pre-breakfast sample obtained after initial voiding upon arising. Their subjects were healthy persons who were not taking any regular medications. To determine whether SUM can be successfully used for patients taking antihypertensive drugs, we estimated daily salt intake in 73 hypertensive patients by SUM and by a food consumption method (FCM) when they were at home, and also by SUM in the hospital with a defined intake of 7 g of sodium chloride (NaCl). Forty-one patients took oral antihypertensive medications once daily, while 32 patients took none. Mean daily salt intakes by SUM during admission were 7-8 g of NaCl in both groups (95% confidence intervals: 5.0-10.6 g in the medication group; 5.2-11.1 g in the no-medication group), which corresponded well to the diet. In contrast, ambulatory daily salt intake by SUM varied widely (95% confidence intervals: 5.5-20.7 g in the medication group; 7.6-22.8 g in the no-medication group). However, the daily salt intakes determined by SUM and FCM correlated significantly with each other in the medication group (r=0.69, p<0.01) and the no-medication group (r=0.66, p<0.01). SUM is therefore a reliable method for evaluating daily salt intake in patients taking antihypertensive medication as well as unmedicated patients.

Relationship between the awareness of salt restriction and the actual salt intake in hypertensive patients.

A 24-h home urine collection was conducted to estimate accurate salt intake in hypertensive outpatients. Using 24-h urinary creatinine excretion as a criterion for success, urine samples were obtained from 534 hypertensive patients. The urinary salt excretion of hypertensive outpatients ranged widely from 1.5 to 23.4 g/day (mean value 9.7 +/- 3.9 g/day). Urinary salt excretion was higher in males than in females (10.6 +/- 4.0 vs. 9.2 +/- 3.7 g/day, p<0.01). Based on the questionnaires, the patients were divided into salt-conscious patients, or those who were careful to reduce their daily salt intake, and non-salt-conscious patients. It was found that urinary salt excretion was lower in the salt-conscious group than in the non-salt-conscious group (9.4 +/- 3.8 vs. 10.6 +/- 4.0 g/day, p<0.01), but that urinary salt excretion adjusted for body weight was not significantly different between the two groups (0.16 +/- 0.06 vs. 0.17 +/- 0.07 g/kg/day). Our results suggest that there was no obvious reduction in the actual salt intake in salt-conscious patients, suggesting the importance of monitoring salt intake by 24-h home urine collection and informing patients of their actual salt intake as a means of encouraging the achievement of salt restriction.

Role of the aldosterone system in the salt-sensitivity of patients with benign essential hypertension.

This study compared responses of blood pressure, plasma concentrations of norepinephrine (PNE) and aldosterone (PA), plasma renin activity (PRA) and urinary excretion of aldosterone during a 5-day period of high salt intake in 11 untreated patients with essential hypertension and 11 age-matched normotensive control subjects. The hypertensive patients all had blood pressures that had been above 160 systolic and/or 90 mmHg diastolic before admission and had decreased to below 150/90 mmHg with only bed-rest and mild salt restriction (6 Gm per day). Sodium balance was also measured before and after high salt intake (16 Gm per day). The hypertensive patients showed both a significant reduction in blood pressure after hospitalization and a significant blood pressure elevation when salt intake was increased. In contrast, no obvious changes in blood pressure were observed in the normotensive subjects. Sodium retention and decreases in PNE and PRA during the high salt period were similar in both groups. However, the reduction in PA and urinary aldosterone excretion in response to excessive salt intake was less pronounced in the hypertensive patients than in the normotensive subjects. The ratio of percentage changes in PA to percentage changes in PRA after salt loading was significantly lower in the hypertensive patients than in the normotensive subjects. In addition, the changes in PA during salt loading were inversely proportional to changes in blood pressure (r = 0.66, p less than 0.01). Thus, it is suggested that the sensitivity of blood pressure to increased dietary salt intake in hypertensive patients may be related to altered aldosterone dynamics, and that the blunt responses of the PA and urinary excretion of aldosterone can be attributed to reduced sensitivity of the adrenal cortex to changes in circulating angiotensin.

Failure of single-session dietary counseling to reduce salt intake in hypertensive patients.

Twelve ambulatory, stable, hypertensive patients were studied to determine the effect of a single, structured session of dietary counseling on daily sodium intake. The patients understood the material presented to them, as measured by testing six weeks after the original session, and they perceived themselves as having substantially reduced their daily salt intake (p less than 0.005); objective assessment of dietry sodium from measurement of 24-hour urinary sodium excretion, however, showed no significant decrease in this patient group. We conclude that single-session dietary counseling in hypertensive patients is unlikely to result in significant reductions in daily salt intake.

Dietary salt intake in hypertensive patients with normal and low plasma renin activity.

Dietary salt intake in hypertensive patients with normal and low plasma renin activity.